Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery

“Despite advances in perioperative care in the last few decades, postoperative pulmonary complications (PPCs) are probably the leading cause of morbidity and mortality in adults undergoing chest and abdominal surgery. PPCs and cardiac complications are commonly regarded as the two major causes of perioperative problems in selected groups of patients undergoing these high-risk surgical procedures. However, PPCs are more common than postoperative cardiac complications and play a bigger role in mortality and healthcare costs. Despite these factors, the natural history of PPCs and the necessity of preventive strategies have not been well recognized in studies to date.”

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Evaluation of Surgical Site Infections by Wound ClassificationSystem Using the ACS-NSQIP

“The wound classification system is an important predictor of postoperative outcomes. Recent studies have focused on elements such as preoperative risk factors and co-morbidities, operative time, prophylactic antibiotic use, and the American Society of Anesthesiology (ASA) physical status score, along with wound classification to predict postoperative surgical outcomes”

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Risk Factors for Chronic Pain after Open Ventral Hernia Repair by Underlay Mesh Placement

“Incisional hernia is one of the most frequent long-term complications after abdominal surgery (11%–20%). After primary repair, rates of recurrence range from 24% to 54%. It has been clearly demonstrated that the use of prostheses for a tension-free repair allows for a
significant reduction in recurrence rate, and even for the treatment of small defects. However, the type and position of the mesh and the mesh fixation technique used are still a matter of debate. The underlay position of the mesh allows for easy treatment of major parietal defects with limited dissection and potentially lower rates of mesh infection, but this position exposes the patient to the risk of small bowel occlusion and enterocutaneous fistula.”

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Risk factors for postoperative cervical haematoma in patients undergoing thyroidectomy (REDHOT)

“In endocrine surgery, thyroidectomy is the most frequently performed surgical procedure.
Morbidity related to thyroidectomy is mainly represented by hypoparathyroidism, recurrent laryngeal nerve injury, and cervical haematoma. These complications can occur at a
considerable rate even if thyroid surgery is performed by highly experienced surgeons.
Obtaining accurate haemostasis during thyroidectomy is crucial to prevent the occurrence of postoperative bleeding and, allowing adequate vision of the anatomical structures, is also important to avert the onset of the other complications.”

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Timing and type of surgical treatment of Clostridium difficile associated disease

“Findings in the literature suggest that prompt surgical treatment of patients with fulminant Clostridium difficile-associated disease (CDAD) is necessary to ensure patient survival. However, controversy remains regarding the best surgical approach and timing. Recent efforts have been made in the creation of a scoring system to predict deterioration and improve patient care. New surgical approaches such as ileostomy and washout have shown promising results, but more rigorous data and longer follow-up, especially with regard to
disease recurrence after ileostomy reversal, are needed to evaluate the true value of these techniques regarding mortality.”

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Emergency Colorectal Surgery in Those with Cirrhosis: Outcomes and predictors of mortality

“Individuals with cirrhosis have higher post-operative morbidity and mortality following major abdominal surgery compared to those without cirrhosis. To quantify this added risk, observational studies and prediction models have been described; however, the majority were derived from historic cohorts and may not reflect the changing epidemiology of
liver disease or advances in both the medical management of cirrhosis and perioperative practices in this high-risk group.”

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